In an essay in the New York Times, cardiologist Saundeep Jauhar, M.D. describes the challenges inherent in linking physician compensation to performance. The problem, Dr. Jauhar writes, is that pay-for-performance programs (“P4P”) create incentives for particular therapies that result in their overuse: pay physicians for prescribing antibiotics, and patients will receive them even if they have no evidence of infection. In addition, P4P encourages “cherry-picking” and discourages physicians from treating the sickest patients for fear of negative statistics.
The same danger lies in many of the physician outcome reporting programs that are gaining in popularity: in the field of cardiothoracic surgery, for example, the California Coronary Artery Bypass Graft (CABG) Outcomes Reporting Program, CCORP, has given rise to a fear on the part of many surgeons of the implications of negative reporting on outcomes if they perform CABG on sick patients.
Recommended Action: Physicians are under increasing pressure – from both patients and payors – for more information about and incentivization linked to quality of care. Greater reliance on both pay-for-performance and outcome reporting metrics are inevitable, despite the manifest problems inherent in both. On an individual level, providers need to approach these trends and their challenges strategically. On a collective level, providers need to take part actively in establishing — and establishing limits on — meaningful quality guidelines before payors and government agencies impose them.
Harry Nelson is a partner in Fenton & Nelson, LLP, a law firm that counsels healthcare providers on business and compliance issues. For additional information, please contact Fenton & Nelson at harry@fentonnelson.com ©Harry Nelson 2008
